Cardiovascular risk associated with the use of glitazones, metformin and sufonylureas: meta-analysis of published observational studies

BACKGROUND: The results of observational studies evaluating and comparing the cardiovascular safety of glitazones, metformin and sufonylureas are inconsistent.To conduct and evaluate heterogeneity in a meta-analysis of observational studies on the risk of acute myocardial infarction (AMI) or stroke in patients with type 2 diabetes using non-insulin blood glucose–lowering drugs (NIBGLD). METHODS: We systematically identified and reviewed studies evaluating NIBGLD in patients with type 2 diabetes indexed in Medline, Embase, or the Cochrane Library that met prespecified criteria. The quality of included studies was assessed with the RTI item bank. Results were combined using fixed- and random-effects models, and the Higgins I(2) statistic was used to evaluate heterogeneity. Sensitivity analyses by study quality were conducted. RESULTS: The summary relative risk (sRR) (95 % CI) of AMI for rosiglitazone versus pioglitazone was 1.13 (1.04–1.24) [I(2) = 55 %]. In the sensitivity analysis, heterogeneity was reduced [I(2) = 16 %]. The sRR (95 % CI) of stroke for rosiglitazone versus pioglitazone was 1.18 (1.02–1.36) [I(2) = 42 %]. There was strong evidence of heterogeneity related to study quality in the comparisons of rosiglitazone versus metformin and rosiglitazone versus sulfonylureas (I(2) ≥ 70 %). The sRR (95 % CI) of AMI for sulfonylurea versus metformin was 1.24 (1.14–1.34) [I(2) = 41 %] and for pioglitazone versus metformin was 1.02 (0.75–1.38) [I(2) = 17 %]. Sensitivity analyses decreased heterogeneity in most comparisons. CONCLUSION/INTERPRETATION: Sulfonylureas increased the risk of AMI by 24 % compared with metformin; an imprecise point estimate indicated no difference in risk of AMI when comparing pioglitazone with metformin. The presence of heterogeneity precluded any conclusions on the other comparisons. The quality assessment was valuable in identifying methodological problems in the individual studies and for analysing potential sources of heterogeneity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0187-5) contains supplementary material, which is available to authorized users

Hydropower dams, river drought and health effects: A detection and attribution study in the lower Mekong Delta Region

The upstream construction of hydropower dams may drastically intensify climate change impacts due to changing the natural river flood-drought cycle and reducing the amount of water that flows into the lower Mekong Delta river, leading to hydrological and environmental health impacts. However, until now the influence of drought on residents’ health in the lower MDR, where river drought is highly sensitive to recently built hydropower plants, has not been examined. The objectives of this study are, for the first time, to detect the health impacts of river drought on residents and to evaluate the contribution of hydropower dams to the impacts of drought on health in the lower Mekong Delta Region (MDR). We applied the multi-step approaches of a Detection and Attribution study. First, we detected the effects of the river drought on the risk of hospitalization using a Multivariable Fractional Polynomials algorithm (MFP). Second, we linked the long-term changes of the river water level (RWL) to the operation of the first hydropower dam in the upper MDR using the interrupted time-series model (ITS). Finally, we quantified the hospitalizations and related economic loss attributed to the river drought. The results show that the percentage changes in risk of all-cause, respiratory, and renal hospitalizations attributed to the river drought were 2%, 2%, and 7%. There were significant reductions in average level and trend of the RWL during the post-1995 period, when the first hydropower dam began operation in the upper MDR, even though the cumulative rainfall in the MDR had not changed. The all-cause hospitalizations attributed to the river drought were 1134 cases during the period 1995–2014, which resulted in total additional cost at two provincial hospitals of US $360,385. This current study demonstrates the link between hydropower dams, river drought, and health impacts. As the MDR is highly vulnerable to climate change, these findings about the devastating impacts of hydropower dams and environmental change have important implications for the lives of downstream residents

The first 100 days of SARS-CoV-2 control in Vietnam

Background: One hundred days after SARS-CoV-2 was first reported in Vietnam on January 23rd, 270 cases were confirmed, with no deaths. We describe the control measures used by the Government and their relationship with imported and domestically-acquired case numbers, with the aim of identifying the measures associated with successful SARS-CoV-2 control. Methods: Clinical and demographic data on the first 270 SARS-CoV-2 infected cases and the timing and nature of Government control measures, including numbers of tests and quarantined individuals, were analysed. Apple and Google mobility data provided proxies for population movement. Serial intervals were calculated from 33 infector-infectee pairs and used to estimate the proportion of pre-symptomatic transmission events and time-varying reproduction numbers. Results: A national lockdown was implemented between April 1st and 22nd. Around 200 000 people were quarantined and 266 122 RT-PCR tests conducted. Population mobility decreased progressively before lockdown. 60% (163/270) of cases were imported; 43% (89/208) of resolved infections remained asymptomatic for the duration of infection. The serial interval was 3·24 days, and 27·5% (95% confidence interval, 15·7%-40·0%) of transmissions occurred pre-symptomatically. Limited transmission amounted to a maximum reproduction number of 1·15 (95% confidence interval, 0·37-2·36). No community transmission has been detected since April 15th. Conclusions: Vietnam has controlled SARS-CoV-2 spread through the early introduction of mass communication, meticulous contact-tracing with strict quarantine, and international travel restrictions. The value of these interventions is supported by the high proportion of asymptomatic and imported cases, and evidence for substantial pre-symptomatic transmission.</p

Preparation of chitosan nanoparticles by spray drying and their antibacterial activity

[[abstract]]Chitosan nanoparticles were prepared from chitosan with different molecular weight by spray drying method. The morphology of chitosan nanoparticles were characterized by SEM and size distribution and zeta potential values were determined. Effect of chitosan solution concentrations, molecular weight of chitosan (MMW, HMW and VHMW) and size of spray dryer nozzles on average size, size distribution and zeta potential values of chitosan nanoparticles were investigated. Moreover, the effect chitosan nanoparticles and chitosan nanoparticles/amoxicillin complex on Staphylococcus aureus was also tested. The results showed that the average size of chitosan nanoparticles were in the range of 95.5 to 395 nm and zeta potential values of 39.3 to 45.7 mV depended on concentration and molecular weight of chitosan. The lower concentration and molecular weight of chitosan were used, the smaller size of chitosan nanoparticles and the higher zeta potential values were obtained. The testing for antibacterial activity against S. aureus indicated that chitosan nanoparticles strongly inhibited the growth of bacteria with the minimum inhibitory concentration (MIC) of 20µg/mL, which were lower than that of chitosan solution and amoxicillin. The antibacterial capacity of chitosan nanoparticles also depended on size, zeta potential values and molecular weight of chitosan. Complex of chitosan nanoparticles/amoxicillin could improve antibacterial activity of amoxicillin.[[notice]]補正完畢[[incitationindex]]SCI[[booktype]]紙本[[booktype]]電子